How to interpret and manage learning needs on placement

1. How to interpret and manage learning needs on placement Sarah Illingworth & Louise Goff

2. Specific Learning Difficulties (SplDs) • SplDs affect the way information is learned and processed • They are neurological (rather than psychological), usually hereditary and occur independently of intelligence • They include: • Dyslexia, • Dyspraxia or Development Co-ordination Disorder, • Dyscalculia, • Attention Deficit Disorder • Highly variable profile • Strengths and weaknesses

3. Common difficulties in SplDs

4. Information processing • Difficulties with taking in information efficiently (this could be written or auditory) • Slow speed of information processing - a 'penny dropping' delay between hearing something and understanding and responding to it Information processing

5. Memory & concentration Memory & concentration • Poor short term memory for facts, times, dates • Poor working memory -difficulty holding several pieces of information while undertaking a task e.g. taking notes as you listen. • Mistakes with routine information • Inability to hold on to information without referring to notes.

6. Memory & concentration Memory & concentration • Weak listening skills, a limited attention span, problems maintaining focus • A tendency to be easily distracted, inability to remain focused

7. Communication skills Communication skills • Lack of verbal fluency or precision in speech • Word-finding problems • Inability to work out what to say quickly enough • Misunderstandings or misinterpretations during oral exchanges • Over-loud speech or murmuring that cannot be clearly heard • Sometimes mispronunciations or a speech impediment may be evident

8. Literacy • Lateness or difficulty in acquiring reading and writing skills • Erratic spelling, difficulty extracting the sense from written material, difficulty with unfamiliar words, an inability to scan text • Particular difficulty with unfamiliar types of language such as technical terminology, acronyms Literacy

9. Organisation & time management • Difficulty presenting a sequence of events in a logical, structured way • Incorrect sequencing of number and letter strings • Tendency to misplace items • Chronic disorganisation • Poor time management: particular difficulties in estimating the passage of time Organisation & time management

10. Direction & navigation • Difficulty with finding the way to places or navigating the way round an unfamiliar building Direction & navigation

11. Sensory sensitivity Sensory sensitivity • A heightened sensitivity to noise and visual stimuli • Impaired ability to screen out background noise or movement • Sensations of mental overload / switching off

12. Visual Stress

13. Visual Stress • Some people with dyslexic difficulties may experience visual stress when reading • Text can appear distorted and words or letters appear to move or become blurred • White paper or backgrounds can appear too dazzling and make print hard to decipher

14. One size does NOT fit all… • Individuals vary greatly in their profile • Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties • Key is to develop and implement coping strategies • Strategies included: technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy • Strategies are prone to break down under stressful conditions which impinge on areas of weakness

15. Stress • People with Specific Learning Difficulties are particularly susceptible to stress, compared with the ordinary population • Leads to impairments becoming more pronounced • As a result many people with Specific Learning Difficulties have little confidence and low self-esteem

16. Areas of Strength • Specific Learning Difficulties are linked to a range of skills: • 'big picture' thinking • problem-solving • lateral thinking abilities • instinctive understanding of how things work • originality & creativity • exceptional visual-spatial skills • Not all people with SplDs will have outstanding talents, but all will have comparative strengths and often demonstrate great perseverance and determination

17. Case Study 1 • Undergraduate student who has disclosed that she has dyslexia • She was diagnosed at school and is engaged with her learning needs • She has had little contact with disability support whilst at university and has not discussed her learning needs with her university lecturers

18. Case study 1 • The university disability support service has assessed that she requires the following adjustments: • 25% additional time for examinations • Examinations to be carried out in a separate room. • Two week extended hand-in for assessed coursework • Lecture notes to be available one week in advance

19. Case Study 1 • What reasonable adjustments would you suggest for this student on their second placement ?

20. Case Study 2 • A student is half way through C placement and isn’t progressing as well as you would expect • She ‘can’t quite pull it together’ and you have no idea why • Her pre-placement form states that she achieves an average academic performance • Her performance on B placement was unremarkable.

21. Case Study 2 • During a visit by the university tutor you identify the following as areas that need improvement: • Lacking consistency in gathering and interpreting patient information required to perform an assessment • Difficultly in remembering key facts. Your concerned that the student has knowledge gaps/deficiencies

22. Case Study 2 • The student seems very disorganised. Work is sometimes handed in late, the student is often late or in the wrong place • Her portfolio is poorly organised and lacks sufficient evidence demonstrating clinical and reflective skills • She finds recording information challenging, making many errors and this process is very time consuming • She is very, very stressed and anxious at times which limits her ability to perform

23. Case Study 2 • What do you think the problem is ? • How are you going to manage it ?

24. Case Study 2 • What will the university do ? • Arrange diagnostic tests for a possible specific learning disability • Work with the placement site to develop reasonable adjustments • Work with the student to support them • Facilitate stress management support at the University • Provide additional contact for both the student and the placement site • Facilitate post-placement discussions of experiences

25. Case Study 2 • What do you have to do: • Facilitate and support reasonable adjustments • Reasonable adjustments have to be agreed by the placement site, student, university • Document your decisions and rationale

26. Reading strategies • Allow extra time for reading. • Present essential reading well in advance of meetings – highlighting important parts if appropriate. • Provide opportunities to discuss reading. • Make word processed documents ‘dyslexia friendly’: • write in a logical sequence • avoid small print (use font size 12 or above) • use a dyslexia friendly font (arial, verdana, tahoma or lucinda sans are best) • use bullet points in preference to sentences where possible • use simple words/avoid overuse of jargon or uncommon words • do not justify the right hand margin – this makes the spaces between words uneven and harder to read if you are dyslexic • space the information so it is not cramped, use short paragraphs to break up dense text • where possible print documents on off white/cream paper

27. Writing strategies • Allow individuals enough time to write up their notes. • Try not to disturb individuals when they are concentrating on their documentation. • Allow them to write a rough draft on scrap paper which you can check before they write it into the notes. • Help students to devise a checklist of key areas to include in certain types of documentation. • Consider devising a ‘sample’ or ‘model’ for different types of documentation to show them the level and content expected • Allow word processing of reports etc where possible

28. Memory Strategies • Help the student to invent and use mnemonics. • Encourage the individual to use ‘to do’ lists rather than trying to remember. • Don’t give too many instructions at once. • Prepare printed ‘handover sheets’ covering core information – the individual can add to these but it will reduce the amount they need to write down and avoids things being missed. • Help a colleague to draw up a plan highlighting important tasks/ deadlines.

29. Memory Strategies • Set clear, measurable targets. • Allow enough time for the person to grasp key information, try not to rush them. • In the case of procedures allow the person a chance to practice (ideally as close as possible to when you explained it or demonstrated it). • Explain things more than once if required. • Where possible give instructions in written and verbal form (you could consider using a digital voice recorder to record sets of instructions).

30. Liaising with colleagues • Try to create an environment which helps colleagues to feel comfortable • anxiety will only make problems worse. • Don’t let people draw attention to mispronounced words, even inadvertently • Try not to use abbreviations as some people find them difficult to interpret and they may mean different things to different people

31. Useful resources • http://www.bdadyslexia.org.uk/about-dyslexia/adults-and-business/dyslexia-and-specific-learning-difficulties-in-adu.html • Dyslexia, dyspraxia and dyscalculia: a toolkit for nursing staff http://www.rcn.org.uk/__data/assets/pdf_file/0003/333534/003835.pdf